| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2740 |
Crown - porcelain/ceramic |
780 |
505 |
$370K |
| D0120 |
Periodic oral evaluation - established patient |
3,134 |
3,125 |
$189K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,789 |
1,508 |
$185K |
| D9430 |
|
5,399 |
4,429 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,559 |
2,553 |
$165K |
| D1110 |
Prophylaxis - adult |
1,753 |
1,747 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,094 |
1,086 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
2,441 |
2,438 |
$111K |
| D1120 |
Prophylaxis - child |
2,555 |
2,545 |
$99K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,421 |
5,094 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,094 |
3,083 |
$37K |
| D0350 |
|
3,885 |
1,533 |
$35K |
| D2954 |
|
288 |
223 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,628 |
1,614 |
$26K |
| D4910 |
|
293 |
291 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,071 |
1,069 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
268 |
196 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,249 |
1,246 |
$14K |
| D0330 |
Panoramic radiographic image |
1,426 |
1,421 |
$14K |
| D4341 |
|
197 |
49 |
$14K |
| D1351 |
Sealant - per tooth |
572 |
145 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
574 |
538 |
$6K |
| D1330 |
|
1,630 |
1,620 |
$0.00 |